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Biomedical subjects

D D Sherry

Publications and source records attributed to D D Sherry.

50 records · Page 3Linked to original sources
PubMed1989

Toxicity and serum levels of methotrexate in children with juvenile rheumatoid arthritis.

Twenty-three children with destructive polyarticular juvenile rheumatoid arthritis (JRA) were treated for 0.5-4.3 years (median 1.6 years) with weekly doses of methotrexate (MTX) (0.11-0.6 mg/kg/week). Serum levels of MTX at 1 hour and at 24 hours after drug administration were obtained at each dosage level and every 3 months after a stable dosage was achieved. No patient had serum levels of MTX that were in the toxic range nor evidence of hematologic, skin, mucous membrane, gastrointestinal, or pulmonary abnormalities. Ten patients had transiently elevated serum transaminase levels. Arthritis symptoms improved in 21 of these JRA patients, and the improvement was significantly associated with a mean 1-hour serum MTX level of greater than or equal to 5.8 x 10(-7)M (P = 0.008) and a dosage of greater than or equal to 0.3 mg/kg/week (P = 0.004). The 1-hour serum level of MTX was correlated with the MTX dosage (r = 0.28, P = 0.005). Our observations suggest that with close monitoring, MTX can be used safely at dosages as high as 0.6 mg/kg/week, and improvement in the symptoms of JRA will become evident when the serum levels of MTX 1 hour after administration approach 6.0 x 10(-7)M.

Administration, Oral↗
PubMed1989

Intermittent intravenous cyclophosphamide therapy for lupus nephritis.

We carried out a preliminary study to determine whether intermittent intravenous cyclophosphamide therapy could be safely and effectively used in the treatment of childhood lupus nephritis. Sixteen children (4 to 18 years of age) with lupus nephritis were treated with cyclophosphamide monthly for 6 months and then every 3 months. Eight children were treated because of corticosteroid-unresponsive active lupus nephritis, with a fall in their creatinine clearance to less than 100 ml/min/1.75 m2, and eight children were treated because of corticosteroid-dependent nephrotic syndrome or active lupus nephritis with unacceptable corticosteroid-induced side effects. Cyclophosphamide treatment was associated with significant improvement at 1 year in mean levels of hemoglobin (11.3 +/- 0.5 to 13.1 +/- 0.3 gm/dl), C3 (52 +/- 5.9 to 108 +/- 13.7 mg/dl), and C4 (7.6 +/- 0.9 to 15.9 +/- 2.2 mg/dl) (all p less than 0.005), despite a significant reduction in mean prednisone dosage (31 +/- 5 to 14 +/- 2 mg/day; p less than 0.005). There was a decrease in 24-hour urine protein excretion from 3121 +/- 913 to 1016 +/- 364 mg/24 hours (p less than 0.05). For children whose initial creatinine clearance was less than 100 ml/min/1.75 m2, creatinine clearance also improved significantly (57.5 +/- 11 to 121 +/- 24.5 ml/min/1.75 m2; p less than 0.05). The long-term safety of intravenous cyclophosphamide therapy and its long-term efficacy in comparison with prednisone alone remain to be established. In the interim, intravenous cyclophosphamide therapy should be reserved for children with severe, unacceptable corticosteroid side effects or with corticosteroid-resistant and potentially life-threatening disease.

Adolescent↗
PubMed1988

Psychologic aspects of childhood reflex neurovascular dystrophy.

Psychosocial factors in 21 families with children affected by reflex neurovascular dystrophy were studied. Each family was interviewed and given a battery of standardized psychologic tests. Two distinct types of families were identified. Fifteen families showed high internal cohesion, expressiveness, and organization and low levels of conflict. Six families showed high overt conflict with low levels of family cohesion, expressiveness, and organization. In all families parental enmeshment with the patient was present. Marital discord was present in 12 families. Thirteen patients had significant school problems (ten had learning disabilities). Although most of the children were described as especially bright, only four had above average intelligence test scores. Four had a history of sexual abuse. The patients and their mothers perceived the health problem as significantly worse than did children with arthritis from whom similar scores had been obtained. Possible role models with similar symptoms were reported by ten patients. These data support the concept that childhood reflex neurovascular dystrophy is frequently a stress-related disease; the therapeutic approach to treating these children and their families must take these psychosocial factors into account.

Adolescent↗
PubMed1986

IgG anti-IgA1 and anti-IgA2 antibodies: their measurement by an enzyme-linked immunosorbent assay and their relationship to disease.

IgG anti-IgA antibodies were measured by an enzyme-linked immunosorbent assay using one IgA1 and one IgA2 (m1) myeloma and a pooled IgA protein preparation as antigens. Class-specific anti-IgA antibodies occurred in 0.8% of non-IgA-deficient sera and 24.3% of IgA-deficient sera. Antibodies reacting with IgA1 only occurred in 2.6% of non-IgA-deficient sera and 6.7% of IgA-deficient sera. Antibodies reacting with IgA2 only occurred in 0.6% of non-IgA-deficient sera and 2.7% of IgA-deficient sera. The prevalence of anti-IgA in IgA deficients with inflammatory disease was higher (81.8%) than in IgA deficients without disease (24.1%) and was accounted for by class-specific antibodies.

Adolescent↗
PubMed1986

The use of lidocaine to reduce the pain of myochrysine injections for children with juvenile rheumatoid arthritis.

Myochrysine (gold sodium thiomalate, GSTM) injections are the therapy of choice for children with refractory juvenile rheumatoid arthritis. In this single blinded study 8 children receiving GSTM were asked to rate their discomfort after a total of 185 injections of GSTM to which were added in random fashion either 0, 0.1, or 0.25 ml of 1% lidocaine. The addition of 0.1 ml of lidocaine was associated with a reduction of the mean complaint of pain on an ordinal pain score of 1-10 from 4.32 for injections containing no lidocaine to 2.54 for injections containing 0.1 ml (p less than .01). Addition of 0.25 ml of lidocaine did not provide a significant increase in pain reduction (p greater than .05).

Adolescent↗
PubMed1985

Anti-IgA antibodies in pregnancy.

A survey of 28,000 pregnant women revealed an incidence of IgA deficiency (serum IgA less than 1 mg per deciliter) of 1 in 450, which is identical to that in a normal blood-donor population of both sexes. Using an enzyme-linked immunosorbent assay (ELISA) in a study of 61 serum samples from IgA-deficient pregnant women, we observed antibodies to IgA2 alone in 20 per cent, as compared with 7.5 per cent of pregnant women not deficient in IgA and no IgA-deficient blood donors. Antibodies reacting with IgA1 alone were present in occasional serum samples (2 to 7 per cent) from all groups studied, and class-specific anti-IgA antibodies were present in 17 per cent of IgA-deficient blood donors and in 16 per cent of IgA-deficient pregnant women. Blocking experiments showed that some serum samples contained an antibody that reacted with both IgA1 and IgA2, whereas others contained two antibodies, one reacting with IgA1 and the other with IgA2. The anti-IgA2 antibodies tended to diminish in titer after delivery. The ELISA was, as expected, more sensitive than the hemagglutination assay. The offspring of IgA-deficient mothers (but not of IgA-deficient fathers) had levels of serum IgA below the normal mean (21 of 27); 12 had levels more than 1 S.D., and seven had levels more than 2 S.D., below the normal mean. Of the seven infants with serum IgA levels more than 2 S.D. below the normal age-related mean, five had mothers with anti-IgA antibodies during gestation. It is possible that maternal anti-IgA exerts a transplacental effect on the fetal immune system, causing IgA deficiency in some instances.

Antibodies, Anti-Idiotypic↗
PubMed1985

Transient thrombocytopenia in systemic onset juvenile rheumatoid arthritis.

Three children have been presented who have had long-standing, typical systemic juvenile rheumatoid arthritis. They also had a transient illness with thrombocytopenia, antiplatelet antibodies, and the simultaneous appearance of anti-DNA antibodies and hypocomplementemia. Other single abnormalities included the development of a positive ANA, Coombs, and lupus bands test. All responded to high-dose steroid therapy. Their similar clinical and serologic findings are noteworthy and represent one of the numerous complications seen in patients with systemic juvenile rheumatoid arthritis.

Adolescent↗
PubMedDate not supplied

Childhood polymyositis as a paraneoplastic phenomenon.

Childhood polymyositis and dermatomyositis are rare conditions that are not generally associated with malignancy even though an association between adult-onset and malignancy has been reported. A child is presented with typical polymyositis in whom an immunoblastic sarcoma subsequently became manifest; the literature also is reviewed concerning the association between malignancy and these childhood conditions.

Biopsy↗
PubMedDate not supplied

Histocompatibility antigens in Osgood-Schlatter disease.

Eighteen unrelated children (12 boys and six girls) with Osgood-Schlatter disease (OSD) were evaluated by history, physical examination, and histocompatibility antigen [human leukocyte antigen (HLA)] determination. Four boys and two girls had pain at sites other than the tibial tuberosity. By history, other related individuals with a diagnosis of OSD were found in six of the 18 families. The distributions of HLA antigens (A, B, and DR) were not demonstrably abnormal. The similarity of OSD and enthesitis accompanying HLA-B27-associated arthropathy may cause diagnostic difficulty. The lack of an association between OSD and HLA-B27 may be of assistance in differentiating the two disorders.

Adolescent↗
PubMedDate not supplied

Autoantibody production in Kawasaki syndrome.

Although a variety of autoantibodies are produced in patients with Kawasaki syndrome (KS), their specificities in many instances are controversial and their role in disease pathogenesis is undetermined. Autoantibody production was studied in 14 patients with Kawasaki syndrome (KS). Antibodies to myeloperoxidase (MPO), the dominant antigen responsible for perinuclear antineutrophil cytoplasmic antibody (pANCA) reactivity, were detected by ELISA in 73% of acute phase and 89% of convalescent phase KS specimens, in contrast to 4% of normal adult control subjects (p < 0.002 and p < 0.001, respectively). MPO and cytoplasmic antineutrophil antibody (cANCA) levels measured by ELISA were significantly elevated above levels for adult normal control subjects (p < 0.005 and p < 0.01, respectively), but not above recently ill childhood controls. Among patients who developed a positive ANCA, antibody titers tended to rise in serial specimens despite clinical improvement. Antibodies to myocardial muscle, cardiac perimysial connective tissue, nuclear antigens (ANA), and smooth muscle were also detected in some KS patients, but titers did not differ significantly from control patients. Autoantibody results were not predictive of patients with echocardiographic abnormalities.

Antibodies, Antineutrophil Cytoplasmic↗